Health reform in Brazil: lessons to consider

US analysts and decisionmakers interested in comparative health policy typically turn to European perspectives, but Brazil-notwithstanding its far smaller gross domestic product and lower per capita health expenditures and technological investments-offers an example with surprising relevance to the US health policy context. Not only is Brazil comparable to the United States in size, racial/ethnic and geographic diversity, federal system of government, and problems of social inequality. Within the health system the incremental nature of reforms, the large role of the private sector, the multitiered patchwork of coverage, and the historically large population excluded from health insurance coverage resonate with health policy challenges and developments in the United States.

[On the Brazilian National Medical Educational Examination]. / Considerações sobre o Provão.

In Brazil, implementation of the so-called "Provão", or National Medical Course Examination, has raised numerous levels of discussion. This article aims to identify patterns in some of the more controversial issues: whether the Exam is really an instrument for evaluation of medical courses themselves, or that of future physicians; adequacy of assumptions underlying the questions as formulated; and lack of precision in the questions.

Cryodestruction of hepatic tumors.

Cryodestruction of hepatic tumors is done by freezing the tumor and an appropriate amount of surrounding normal tissue in situ. The goal is complete destruction of malignant tissue. Local and systemic host mechanisms activated by the cold injury complete the process. Resorption of devitalized tissue and stabilization of the residual scar occurs during the ensuing months. Immune factors may contribute to the long-term process of cryodestruction although such effects are inconstant and ill defined. The purpose of this overview is to delineate the mechanisms of cryodestruction, briefly summarize clinical results and discuss the technique for treatment of hepatic tumors.

From a policy of inequality to a proposal of equity: political processes and health care in the municipality of São Paulo.

A tentative analysis is made of the recent São Paulo experience in health care management, in which the chief guideline has been to create institutional space for grass-roots and health worker participation within the State apparatus. The analysis takes Brazil's recent health policies and the so-called Sanitary Reform movement as reference points. The issue is approached from the angle of democracy and democracy's possibilities in the context of a society characterized by tremendous social inequalities, and in the context of the current international and national neoliberal offensive.